Investigators Identify Factors Associated with Opioid Overdose Post Prescription

Scott Weiner, MD, MPH

Because the opioid epidemic continues to be a public health crisis in the US, investigators aimed to asses the patient and prescription-related factors associated with opioid-related overdose.

Scott Weiner, MD, MPH, Department of Emergency Medicine, Brigham and Women's Hospital, led a team of investigators in conducting a cohort study that evaluated opioid-naive adult patients.

The main outcome was an overdose event with a follow-up to identify the fatality of the opioid overdose. The primary risk factors included being 75 years or older, being male, recieving Medicaid or Medicare Advantage coverage, having a comorbid substance use disorder or depression, and having medical comorbidities.

Examining the Problem

"Each prescription of an opioid to a previously opioid-naive patient creates the potential for the development of chronic opioid use and opioid use disorder," investigators wrote.

Although the use of opioid medications has decreased, the US still had 168.9 million opioid prescriptions in 2018. Previous literature has reported that the initial prescription amount or length of use is associated with the development of long-term use.

The prescription filling patterns of patients with long-term use are described by prescription drug monitoring programs. However, these programs do not collect data about drug indications, comorbid conditions, the patient's environment, or intervening outcomes, such as opioid use disorder or overdose.

Investigators addressed data source limitations by combining claims data with several public health data sets to create the Oregon Comprehensive Opioid Risk Registry, a comprehensive analysis of risk factors after the initiation of opioid therapy.

Comprehensive Analysis

The Oregon Comprehensive Opioid Risk Registry that investigators created, links all payer claims data to other health data sets in the state of Oregon.

In this cohort study, the observational, population-based sample of patients had first filled an opioid prescription in 2015, with follow up taking place until the end of 2018.

During the follow up period investigators identified fatal or nonfatal opioid overdoses for the primary outcome. The data were analyzed from March 2020-June 2021.

Identifying Patient and Prescription Factors

The highest risk of overdose among the 236,921 patients in the cohort was being 75 years of age or older, compared with those aged 35-44 years.

The following risks were also significant: being male; those who were dually eligible for Medicaid and Medicare Advantage; had Medicaid, or had Medicare Advantage compared with those who had commercial insurance; those with comorbid substance use disorder; those with depression; those with comorbidities compared with those without.

Additonally, increased risk was observed in patients who filled oxycodone or tamadol compared with codeine; used benzodiazepines; used concurrent opioids and benzodiazepines; or filled opioid prescriptions from 3 or more pharmacies within 6 months.

"These findings may guide opioid counseling and monitoring, the development of clinical decision-making tools, and opioid prevention and treatment resources for individuals who are at greatest risk for opioid overdose," investigators wrote.

The study, "Factors Associated With Opioid Overdose After an Initial Opioid Prescription" was published in JAMA Network Open.